Dr Monique Jonas1
1University Of Auckland, Auckland, New Zealand
Biography:
Monique Jonas is an Associate Professor at the University of Auckland’s School of Population Health. Her research addresses ethical concerns in health, decision-making and the relationship between family and state. She has served on New Zealand’s National Health Committee, National Ethics Advisory Committee and Health Research Council Ethics Committee.
Abstract:
In July 2024, Te Whatu Ora (Health New Zealand) released a government-commissioned independent review of two waitlist prioritisation tools developed within different regional health services. These tools, referred to as equity adjustors, attempted to correct for documented inequities in access to health care and health outcomes. They apply marginal additional priority weighting for surgical candidates domiciled rurally or in an area of socio-economic deprivation or of Māori or Pacific ethnicity. The review concluded that the overall intent of the tools was legitimate, although there were flaws in their design and implementation. It recommended that the tools should remain in use whilst improvements were made, however Te Whatu Ora has elected to discontinue them.
This presentation briefly presents the equity adjustor tools and considers their most contentious element: the inclusion of ethnicity as a basis for prioritisation. I unpack a claim which circulated widely when the equity adjustors were drawn to public attention: that it is racist to factor a person’s ethnicity into decisions about whether and when to offer them health treatment. Drawing upon scholarship on affirmative action, I argue that inclusion of ethnicity within prioritisation tools can be justified when there is evidence that ethnicity mediates access to healthcare and health outcomes. I point to the need for high quality data to inform priority-setting, a procedurally just governance process and proportionate weightings to ensure the legitimacy of equity adjustment.